Survival comparison of patients undergoing elective transjugular intrahepatic portosystemic shunt (TIPS) creation with intermediate and high Model End Stage Liver Disease (MELD) scores

Presented During:

Wed, 4/1/2020: 4:03 PM  - 4:12 PM 
Washington State Convention Center  
Room: Room 609  

Final ID:

324 

Poster Type:

Scientific Session 

Authors:

M Joh1, M Mutonga2, E Li2, A Riaz3, S Mouli4, L Kulik2, R Lewandowski3, R Salem5, B Thornburg2

Institutions:

1Mcgaw Northwestern Memorial Hospital, Chicago, IL, 2N/A, Chicago, IL, 3Northwestern University, Chicago, IL, 4Northwestern University Feinberg School of Medicin, Chicago, IL, 5Northwestern Memorial Hospital, Chicago, IL

First Author:

Maria Joh  
Mcgaw Northwestern Memorial Hospital
Chicago, IL

Co-Author(s):

Martin Boniface Gitobu Mutonga  
N/A
Chicago, IL
Emily Li  
N/A
Chicago, IL
Ahsun Riaz, MD  
Northwestern University
Chicago, IL
Samdeep Mouli, MD  
Northwestern University Feinberg School of Medicin
Chicago, IL
Laura Kulik, MD  
N/A
Chicago, IL
Robert J. Lewandowski, MD, FSIR  
Northwestern University
Chicago, IL
Riad Salem, MD, MBA, FSIR  
Northwestern Memorial Hospital
Chicago, IL
Bartley G. Thornburg, MD  
N/A
Chicago, IL

Presenting Author:

Maria Joh  
Mcgaw Northwestern Memorial Hospital
Chicago, IL

Purpose:

To assess the safety of performing elective transjugular intrahepatic portosystemic shunt (TIPS) placement for ascites or hepatic hydrothorax in patients with intermediate MELD scores of 11-17 and high MELD scores of 18-24.

Materials:

This was an IRB-approved, HIPAA-compliant, single center, retrospective cohort study, including a total of 316 patients who underwent elective TIPS between 2005 and 2015 using PTFE-covered stents for refractory ascites and/or hepatic hydrothorax. Lab values, transplantation status, and survival were analyzed for MELD scores of 11-17 and MELD scores of 18-24. Independent sample t test was used to compare days of survival. One-month mortality was analyzed using the Area Under Receiver Operating Characteristic (AUROC) curves and compared using the paired samples t test. Survival curves were generated using Kaplan-Meier method and were compared using the log-rank test. P values <0.05 were considered statistically significant.

Results:

From a total of 613 TIPS patients, 316 were identified to have undergone elective TIPS for refractory ascites and/or hepatic hydrothorax. From those, 170 patients had MELD scores of 11-17 and 60 patients had MELD scores of 18-24. The mean lengths of survival days were not significantly different between the groups (MELD11-17: 1151 days, MELD18-24: 987 days, p = 0.461). Survival over time assessed by Kaplan-Meier curves for MELD11-17 and MELD18-24 groups were not significantly different (p = 0.108). AUROC curves for MELD score to predict 1-month mortality for MELD11-17 and MELD18-24 groups were not significantly different (0.75 and 0.67 respectively, p = 0.62).

Conclusions:

There was no significant difference in OS between MELD11-17 and MELD18-24 groups in patients who had elective TIPS placed for recurrent ascites or hepatic hydrothorax. The current American Association for the Study of Liver Diseases guideline (AASLD) recommends a MELD score threshold of under 15-18 for elective TIPS procedures. However, the lack of difference in survival between MELD11-17 and MELD 18-24 groups in this study suggests that elective TIPS may be safely performed in patients with higher MELD scores than is currently reflected in the AASLD guidelines.

Abstract Categories:

TIPS and Portal Hypertension

Keywords:

MELD
TIPS